Treating poverty

On my way to work one morning, I made a detour to the medical ward to check on a patient we had referred a few days earlier. When I arrived, I was told that that patient had been discharged. Instead, I was shown another young woman who was believed to be suffering from an eating disorder. I found her sitting on the floor, next to her bed, surrounded by a group of medical interns. They had run some tests, and found her to be in good health. What however perplexed them was her refusal to speak, eat or drink. Simply discharging her was ethically improbable. By coincidentally walking into the ward that morning, I had presented the next best option; the mental health unit. Fortunately she was willing. Without fuss, she silently followed me across the hospital campus to the ward.

For the next couple of days, we communicated by passing notes back and forth. I learned that she was devastated about not being able to return back to school. She had been scheduled to attend Gulu University next semester, but would not because her parents could no longer afford the tuition. In response, she had withdrawn from her environment and began the process of starving herself. After several weeks of food deprivation, she collapsed on the side of the road. A motorcyclist found her and transported her to the hospital.

Working in Uganda, I have often seen a direct correlation between poverty and mental health issues. Epidemiological studies corroborate a correlation between socioeconomic factors such as poverty, urbanization, and capitalism and an increased occurrence of psychopathology (Watkins and Shulman, 2008). Poverty is not only the condition of not having income, but a convergence of social, political and historical factors exerting tremendous influence on ones options. On a personal level, poverty affects self-esteem and a sense of purpose which further leads to emotional trauma. It is described as “an experience of social violence against the physical and mental integrity of the person” (p.78). The young woman’s symptoms were somewhat a crude expression of her macro-social reality.

Considering that “most mental disorders have their highest prevalence rates in the lowest socioeconomic class” (Watkins & Schulman, 2008, p. 63), it is surprising that mental health practitioners have not yet begun to actively treat poverty as a form pathology itself. Instead of only focusing on locating and treating disorders within the individual, we need to also acknowledge symptomology as a subverted reaction to what is not right in the person’s environment.